Cocaine consumption quadruples the risk of sudden death in people between 19 and 49.

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This might explain the sudden death of a friend who used to be a user.

A joint piece of research conducted by the UPV/EHU, the Basque Institute of Forensic Medicine, and the Biomedical Research Centre Network into Mental Health (CIBERSAM) of the Carlos III Institute of Health links, for the first time, the increase in sudden cardiovascular death with the recent consumption of cocaine. In people in the 19-49 age bracket this risk is quadrupled. In fact, cocaine consumption doubles the risk of death of cardiovascular origin that can be attributed to smoking, and becomes the main risk factor among subjects under 50.

What is more, this study is the first one conducted using forensic samples taken from deceased individuals. So they examined all the sudden deaths that underwent forensic analysis and which took place in Bizkaia over a seven-year period, between January 2003 and December 2009. The post-mortem examinations were conducted by the only service existing in the province: the Forensic Pathology Service of Bizkaia of the Basque Institute of Forensic Medicine. The research has been published by the specialised journal Addiction, the second most important international publication in the field of addictions in which a total of 20 journals are registered.

Cocaine is cardiotoxic and a vasoconstrictor which is why there is a risk of sudden death and not just from "overdose". I don't remember exactly but it messes up with the sodium / potassium regulation of the heart. Also, the ages could be related to the average age of cocaine users. Not to mention that cocaine is notorious for being cut with things that can exacerbate this problem, though, even pure cocaine is still cardiotoxic on it's own.